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Acne Nodules

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Nodules are one of the inflammatory acne lesions that appear and spread on the skin during severe acne breakouts. Even though they can be painful and cause acne scars, they last long and they are difficult to treat. Find out how to clear acne nodules without causing extensive damage to the skin.

Acne vulgaris is a common skin disease that is characterized by the appearance of certain lesions on the skin. Acne lesions can be divided into groups: inflammatory and non-inflammatory lesions.

Non-inflammatory acne lesions include acne comedones such as whiteheads and blackheads.

Inflammatory acne lesions are papules, pustules, nodules, and cysts.

The non-inflammatory acne lesions are the first lesions to appear during acne breakouts. However, as mild acne becomes more severe, inflammatory acne lesions such as nodules appear on the skin too.

Acne affects the areas of the skin where sebaceous follicles are in abundance. Therefore, acne lesions are mostly found on the face, neck, upper chest, and back. In severe acne cases, nodules can extend all the way to the upper arms, thighs, and buttocks.

Different factors can cause acne. However, the most important causes of acne are hormones and infections.

Hormones are the chief cause of adolescent acne. These hormones are androgens that are produced in high amounts in both males and females. When androgens such as testosterone and dihydrotestosterone (DHT) get to the skin, they cause the enlargement of the sebaceous glands and increased the production of sebum.

The excess sebum then serves as a growth nutrient for acne-causing bacteria such as Propionibacterium acnes. All inflammatory acne lesions including nodules are caused by the actions of these bacteria.

What Are Acne Nodules?

Acne nodules are the large, hard, painful bumps that appear under the skin surface during the later stages of acne breakouts.

They are similar in appearance to papules but they are larger, raw, and sensitive to touch. They also look like cysts but they are not filled with pus. Both nodules and cysts appear during late moderate acne to severe acne breakouts.

Nodules are stable structures that can last a long time. They can worsen especially when squeezed. Aggravated nodules can cause even deeper infections in the dermis, spread over a wide area, and grow bigger.

Nodules can also lay dormant for a long time even though they are unresolved. This sort of nodules flares up now and then.

Nodules can cause extensive scarring to the skin. To minimize the acne scars caused by nodules, cysts must be carefully treated by lessening the swelling instead of popping the lesion.

Other Acne Lesions

Other acne lesions besides nodules include comedones, papules, pustules, and cysts.

Comedones: These are the whiteheads and blackheads that signal the first acne breakout.

Whiteheads are also called closed comedones. They appear as white specks on the skin and like blackheads, they are restricted to parts of the face during mild acne breakouts. Also like blackheads, whiteheads are made from pores clogged with a mixture of sebum, dead skin cells, and bacteria. However, whiteheads do not last as long as blackheads.

Blackheads are also called open comedones. They appear as dark spots on the skin. They are formed from the partial blockage of skin pores by dead skin cells, sebum, and bacteria.

Because blackheads are only partially blocked, the sebum in the pores is exposed to air oxidation. This causes the hardening and the darkening of the sebum. Therefore, the black coloration of blackheads is derived from melanin, the skin pigment, mixed with oxidized sebum.

Papules: Papules are one of the first groups of inflammatory acne lesions to appear on the skin. In a way, they are the precursors of nodules.

Papules are red, tender, inflamed bumps with no heads that appear on the skin. When squeezed, they may traumatize the skin enough to give rise to nodules and cause scarring.

Pustules: Pustules look like papules except that they are filled with pus.

Pustules are also referred to as zits. They appear as inflamed bumps of red circles but with white or yellow centers.

Cysts: Cysts are larger than pustules in the same way that nodules are larger than papules. They are also filled with pus-like pustules.

Cysts give cystic acne its name. When squeezed, they cause deeper infections and inflammation. Cysts are painful, stable acne lesions and they can cause acne scars too.

How Nodules Are Formed

The increased production of sebum is the first step in the appearance of acne lesions such as nodules.

The excess sebum serves as an ideal growth environment for acne-causing bacteria. These bacteria not only increase in number but also turn from harmless commensals into harmful pathogens.

Nodules are formed from the buildup of sebum, dead skin cells, and bacteria in the follicles. However, unlike papules, nodules are formed from pore blockages deep in the skin. This causes deep tissue damage and a correspondingly extensive inflammatory response from the immune system.

An acne-causing bacterium like P. acnes can cause inflammation by the enzymes it secretes as well as the antigens it produces.

For example, P. acnes secretes lipases which break down the lipids in the sebum to proinflammatory lipids, and proteases which break down immune cells such as neutrophils.

The damage caused by this bacterium alerts the immune system which then sends inflammatory factors such as leukotrienes and bradykinin (bradykinin increases the sensitivity of the skin to pain; therefore, it contributes to the pain felt from nodules).

The immune reaction called up is not a specific response but a general response. Therefore, one of its presentations is local inflammation at the site of injury.

The inflammation caused by the immune system is really a way to protect the tissues from further damage. Without this inflammation, tissue repairs cannot proceed.

However, P. acnes is a difficult pathogen to overcome by this immune response.

It keeps aggravating the skin, causing more damage and, therefore, greater inflammation. Soon other proinflammatory factors such as interleukin and tissue necrosis factor are called to the sites of injury.

These factors respond to the proinflammatory lipids produced by P. acnes. The antigens produced by this bacterium also attract specific antibodies and even T-cells.

Therefore, nodules are formed from the sustained immune response to bacterial damage in the tissues of the skin. Since the immune cells need to be constantly produced to sustain the inflammation, nodules signify present and continuous infection of and damage to the skin.

Home Remedies for Nodular Acne

There are natural remedies that can be used at home to reduce the number and severity of nodules.

These remedies include herbal extracts, vitamins, and minerals. Because these natural remedies possess anti-inflammatory, antibacterial, and antioxidant properties, they can reduce the swelling of nodules, remove the bacteria aggravating the skin and mop up all free radicals and toxins produced from bacterial metabolism.

Tea tree oil and aloe vera are two examples of such home remedies. They can be applied directly on the skin to kill off acne-causing bacteria and hasten the healing of the skin.

Other effective herbal extracts include ginger, honey, and green tea.

These remedies can be prepared as a paste or lotion and applied on the skin as acne masks. Acne masks made out of natural remedies are particularly effective for shrinking nodules.

Other natural remedies for treating acne nodules include zinc (which is a natural antibacterial agent), omega-3 fatty acids (which have anti-inflammatory properties), and vitamins A, C, and E (which are all excellent antioxidants).

Most natural acne products combine different remedies to produce better results. A good example is Actimine, an acne supplement, which is formulated with vitamins C and E, zinc and selenium as well as MSM (methylsulfonylmethane) and gum guggul.

Medications for Nodular Acne

There are also conventional acne medications for lessening the swelling of acne nodules.

The most popular drug that dermatologists use to treat nodular acne is cortisone which is directly injected into the nodules. This provides a controlled shriveling of the nodules and also reduces the chances of scarring.

Oral corticosteroids such as prednisone are also used for treating nodular acne.

Other medications that work by different mechanisms can also be prescribed. Some of these drugs kill off the acne-causing bacteria while others prevent the androgen stimulation that causes the production of excess sebum.

Topical OTC acne products including active ingredients such as benzoyl peroxide and salicylic acid may shrink nodules. These agents are primarily antibacterial agents and exfoliants.

Stronger medications such as oral and topical antibiotics are also available for killing off acne-causing bacteria. However, these bacteria quickly develop resistance to those antibiotics. For this reason, antibiotics are rarely used alone in the treatment of nodular acne.

Anti-androgens such as spironolactone and oral contraceptives containing estrogen and progestins are also effective for breaking the chain of events that eventually promote the formation of nodules.

These medications block androgens such as testosterone from interacting with the sebaceous glands. Therefore, they reduce the production of sebum and prevent the runaway growth of bacteria such as P. acnes.





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